Diagnostic changes as a reason for the increase in papillary thyroid cancer incidence in Geneva, Switzerland

Objective: Several studies have reported upward incidence trends of papillary thyroid cancer. It is unclear whether these trends reflect a real risk increase, by some attributed to iodine supplementation, or an artificial one, due to increased diagnostic activity or changed histological criteria. This study examines if these artificial factors explain the increased papillary thyroid cancer incidence in the Swiss canton of Geneva. Methods: All thyroid carcinomas (n = 436) recorded between 1970 and 1998 at the Geneva Cancer Registry were considered. European age-adjusted incidence trends were estimated using linear regression analysis. For papillary cancers we evaluated diagnostic modalities and way of presentation (in particular microcarcinoma < 1 cm or silent carcinoma). In addition, we reviewed the histological slides of follicular carcinomas. Results: Papillary thyroid cancer incidence increased significantly from 0.7 to 1.8/100,000 for men and from 3.1 to 4.3/100,000 for women between 1970-74 and 1995-98. The proportion of microcarcinomas and silent carcinomas increased from 17% to 24% between 1970-79 and 1990-98. At histological review, follicular cancers were more often reclassified as papillary cancer for cases diagnosed between 1970 and 1979 than for cases diagnosed between 1990 and 1998 (45% vs 25%, p = n.s.). Conclusions: The increasing papillary thyroid cancer incidence seems mainly due to changes in histological diagnostic criteria and, to a lesser extent, to increased diagnostic activity. If confirmed, the results of this study indicate that fears of increasing incidence rates of papillary thyroid cancer should not prevent implementation of adequate programs of iodine supplementation in the many areas where iodine deficiency still prevail

Tumor Location of the Lower-Inner Quadrant Is Associated with an Impaired Survival for Women With Early-Stage Breast Cancer

Background: There is growing evidence that tumors of the inner quadrants (especially the lower-inner quadrant) metastasize more often to the internal mammary chain (IMC). As these metastases are not investigated, patients with lower-inner quadrant tumors have an increased risk of being under-staged and under-treated and may therefore have a higher risk of death from breast cancer. Methods: We identified all 1522 women operated for stage I breast cancer between 1984 and 2002 recorded at the population-based Geneva Cancer Registry. We compared breast cancer mortality risk by tumor location with multivariate Cox regression analysis that accounted for all factors linked to tumor location and survival. Results: Ten-year disease-specific survival was 93% (95%CI: 91-94%). Patients with breast cancer of the lower-inner quadrant (n=118; 7.8%) had an importantly increased risk of dying of breast cancer compared to women with breast cancer of the upper-outer quadrant (multiadjusted Hazard Ratio: 2.3, 95%CI: 1.1-4.5, P=0.0206). The over-mortality associated with this quadrant was particularly evident for tumors >10 mm (multiadjusted HR: 3.6, 95%CI: 1.6-7.9, P=0.0016). There was no increased breast cancer mortality risk for tumors located in other quadrants. Conclusions: Tumor location in the lower-inner quadrant is an independent and important prognostic factor of stage I breast cancer. Further research is needed to evaluate if the over-mortality of patients with stage I cancer of the lower-inner quadrant is indeed a result of under-treatment due to undetected IMC metastases. If so, patients with stage I breast cancer of the lower-inner quadrant are good candidates for systematic IMC investigatio

Determinants of genetic counseling uptake and its impact on breast cancer outcome: a population-based study

Genetic counseling and BRCA1/BRCA2 genes testing are routinely offered in a clinical setting. However, no data are available on the proportion of breast cancer patients with a positive family history undergoing genetic counseling. By linking databases of the Oncogenetics and Cancer Prevention Unit at the Geneva University Hospitals and the population-based Geneva Cancer Registry, we evaluated the uptake of genetic counseling among 1709 breast cancer patients with familial risk of breast cancer and the determinants of such a consultation process. We also studied the impact of genetic counseling on contralateral breast cancer occurrence and survival. Overall, 191 (11.2%) breast cancer patients had genetic counseling; this proportion was 25.1% within the high familial risk group. Recent period of diagnosis, early-onset breast cancer, female offspring, high familial risk, tumor size, and chemotherapy treatment were statistically significantly associated with genetic counseling uptake in multivariate analysis. More than 2% of patients had developed contralateral metachronous breast cancer. An increased risk of contralateral breast cancer of borderline significance was found for patients who had genetic counseling versus those who had not (Cox model adjusted hazard ratio 2.2, 95% confidence intervals 1.0-5.2, P=0.063). Stratification by BRCA1/BRCA2 mutation status showed that the occurrence of contralateral breast cancer was 8-fold higher among mutation carriers compared with non-carriers. Age-adjusted overall survival and breast cancer-specific survival were not significantly different between patients who underwent genetic counseling and those who did not. In conclusion, we observed a significant increase in the use of genetic counseling over time and found that breast cancer patients with high familial risk had more often genetic counseling than those with moderate familial risk. A more thorough evaluation of sociodemographic and clinical predictors to attend the cancer genetic unit may help improving the use of genetic counseling services for at-risk individuals at a population level

Testicular cancer in Geneva, Switzerland, 1970-2012: incidence trends, survival and risk of second cancer

This paper describes the testicular cancer trends for incidence, survival, socio-economic status (SES) disparities and second cancer occurrence in Geneva, Switzerland, a high-risk population

Abstract P3-07-09: Trends and determinants of breast cancer survival among unscreened women: A population-based study

Abstract Background: Breast cancer mortality has been declining in many western countries, including Switzerland,since the late 1980s. This has largely been credited to mammography screening and improved treatment. However, mortality trends are also decreasing among unscreened women, though most breast cancer deaths still occur in that population. Objective: The objective of this study was to analyse trends in,and factors affecting the survival of, women whose breast cancer was not detected by screening in the Geneva female population from 1990 to 2007. In Geneva an organized screening programme started in 2001 while opportunistic screening has existed since the beginning of the 1990s. Methods: The study population comprised1696 women aged 50-69 years oldwith invasive breast cancer that was not detected by screening and that was recorded at the population-based Geneva cancer registry. We studied tumour characteristics and prognostic factors across 6 time periods through chi square and trend tests. To assess whether breast cancer specific survival had improved over time, we calculated 5-year specific survival and performed multivariate Cox proportional hazard models to assess independent determinants of mortality. Results:Median age of the women at diagnosis was 59 years. During the 18 year study periodthere was a decrease in the proportion of diagnoses among women of low social class (25.8% in 1990-92 vs 17.3% in 2005-07, p=0.001). No change in the distribution of stage at diagnosisor hormone receptor status was observed, while between the first and last period there was an increase in cancers with lobular morphology (6.8% vs. 19.0%, p&amp;lt;0.001), and a decrease in poorly or undifferentiated cancers (36.7% vs 28.7%, p&amp;lt;0.001). The use of breast conserving surgery with radiotherapy (BCS), chemotherapy and endocrine therapy increased significantly along the period (41.2% to 58.8%, p&amp;lt;0.001; 41.6% to 52.8, p=0.030; and 34% to 69.9%, p&amp;lt;0.001, respectively). Five year breast cancer-specific survival was 82% in 1990-92 (95% Confidence Intervals [95%CI] 77-87) and 89% in 2005-07 (95% CI: 83-92; log rank test=8.68, p=0.122). In the Cox multivariate model there was a trend towards improved survival, but it was only statistically significant when comparing the period 2005-07 to the first period (Hazard Ratio 0.47, 95%CI: 0.22-0.98). Increasing age, stage, and grade, hormone receptor–negative disease, and not receiving BCS or endocrine therapy were all independently associated with a worse breast cancer–specific survival. Conclusions:We observed an improvement in survival only in recent years among women whose breast cancers were not detected by screening; this appears to be associated with improved treatment. This suggests that the breast cancer mortality reduction observed in Switzerland since the late 1980s is not likely attributable to changes in treatment before 2005, but rather to the generalization of screening. Citation Format: Elisabetta Rapiti, Thomas Agoritsas, Massimo Usel, Robin Schaffar, Hyma Schubert, Christine Bouchardy. Trends and determinants of breast cancer survival among unscreened women: A population-based study [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P3-07-09.</jats:p

Impact of family history of breast cancer on tumour characteristics, treatment, risk of second cancer and survival among men with breast cancer

Male breast cancer patients have a higher risk of developing a second primary cancer, but whether this risk differs according to the family history of breast or ovarian cancers remains to be elucidated. We aimed to determine the effect of a positive family history among men diagnosed with breast cancer on tumour characteristics, treatment, second cancer occurrence and overall survival

Determinants of genetic counseling uptake and its impact on breast cancer outcome: a population-based study

Genetic counseling and BRCA1/BRCA2 genes testing are routinely offered in a clinical setting. However, no data are available on the proportion of breast cancer patients with a positive family history undergoing genetic counseling. By linking databases of the Oncogenetics and Cancer Prevention Unit at the Geneva University Hospitals and the population-based Geneva Cancer Registry, we evaluated the uptake of genetic counseling among 1709 breast cancer patients with familial risk of breast cancer and the determinants of such a consultation process. We also studied the impact of genetic counseling on contralateral breast cancer occurrence and survival. Overall, 191 (11.2 %) breast cancer patients had genetic counseling; this proportion was 25.1 % within the high familial risk group. Recent period of diagnosis, early-onset breast cancer, female offspring, high familial risk, tumor size, and chemotherapy treatment were statistically significantly associated with genetic counseling uptake in multivariate analysis. More than 2 % of patients had developed contralateral metachronous breast cancer. An increased risk of contralateral breast cancer of borderline significance was found for patients who had genetic counseling versus those who had not (Cox model adjusted hazard ratio 2.2, 95 % confidence intervals 1.0-5.2, P = 0.063). Stratification by BRCA1/BRCA2 mutation status showed that the occurrence of contralateral breast cancer was 8-fold higher among mutation carriers compared with non-carriers. Age-adjusted overall survival and breast cancer-specific survival were not significantly different between patients who underwent genetic counseling and those who did not. In conclusion, we observed a significant increase in the use of genetic counseling over time and found that breast cancer patients with high familial risk had more often genetic counseling than those with moderate familial risk. A more thorough evaluation of sociodemographic and clinical predictors to attend the cancer genetic unit may help improving the use of genetic counseling services for at-risk individuals at a population level